Dried Blood Spot Screening for Cardiometabolic Risk Markers shows Benefits of Exercise

The prevalence of diabetes and cardiovascular disease is increasing at an alarming rate. Several clinical and observational studies have demonstrated reduced risk of diabetes when physical activity increases. Simple screening tools are needed to monitor effects of treatment interventions in individuals at high risk.

At ZRT Laboratory in Beaverton, Oregon we assessed the application of dried blood spot technology to measure important cardiometabolic risk markers. Dried blood spot collection has advantages compared to conventional blood draws, such as minimal invasiveness, low sample volume, convenience of repeated measurements and ease of sample storage and transport.

Fifteen participants (28- 63 years of age) enrolled in a fitness study that included 30 minute exercise/ brisk walking five days a week for four months. Levels of insulin, hemoglobin A1c, C-reactive protein and triglycerides were measured in blood spot samples obtained by a simple and easy finger stick before and after the program. Dried blood spot samples were stored at -20C until used for analysis using modified methods developed in house from commercially available assays.

Insulin levels decreased significantly ; triglycerides dropped by 18% and C-reactive protein levels also showed significant improvement. The HbA1c levels remained unchanged during the program.

In conclusion, exercise/ brisk walking for 30 minutes five days a week for four months improved cardiometabolic risk factors independently as confirmed by dried bloodspot testing. This simple screening method has important implications for monitoring overall cardiometabolic health of high risk individuals.

Which is more important- C Reactive Protein or Cholesterol?

I wish to open this discussion to get feedback from all those clinicians and researchers out there struggling to find out which one is a better predictor of overall risk of cardiovascular events. Many of us and in fact most of us have been focussed on the cholesterol levels to determine the risk until a recently published study (JUPITER Study) in New England Journal of Medicine reported that C Reactive Protein (CRP) may be a better predictor and an independent marker of cardiovascular risk as opposed to just LDL cholesterol. The study showed that patients with high LDL cholesterol and high CRP levels were at higher risk than those with high LDL cholesterol but low CRP levels. It was also observed that patients with normal LDL cholesterol with high CRP levels are at higher risk than those with normal LDL cholesterol and low or normal CRP levels. In these patients, measuring only the LDL cholesterol may not be very helpful or in other words, these patients may not be identified as those at risk and may end up developing a coronary artery disease.

We know that CRP is released in response to any inflammation in the body. Several studies have shown a connection between inflammation and atherosclerosis, which is basically attested by the JUPITER study.

Does that mean that we should start measuring CRP levels regularly to screen or monitor patients at high risk? Is it still important to measure LDL cholesterol? Do we really need to know the triglyceride levels? Should we still look at other risk markers now that we have CRP as an emerging independent marker?

I personally feel that body does not work in isolation and relying upon just one or two risk factors may not be a smart decision. It is extremely important to consider the overall balance of major physiological functions within the body to get a comprehensive picture of overall risk.

Ten Simple Lifestyle Changes to Reduce your Risk of Heart Disease

With obesity rates continuing to rise to epidemic levels, the fattening of America goes hand in hand with a cluster of health problems generally referred to as “metabolic syndrome,” including high blood pressure and high levels of the blood fats, triglyceride and/or cholesterol. Insulin resistance, where the action of insulin in the body is impaired and fails to control blood sugar levels, also complicates the picture. When these things happen all at the same time, as is generally the case, their collective impact is to raise Type II diabetes and cardiovascular disease risks simultaneously. Increasingly referred to in medical circles as the “cardiometabolic syndrome,” people with even one of its components may be at increased risk for others. Knowing what to watch for can make the difference between having, or preventing, full-blown disease; so early detection of risk factors and proactive preventive measures can help individuals lead a active, healthy and happy life.

There are 10 simple lifestyle changes that I wish to outline below, which can lower the overall risk of getting a heart disease. This information is not very new to us and we talk about the importance of all these facts in our everyday lives, but the question is how many of us consider these seriously.

More than a century and billions of dollars in medical research, hundreds and thousands of clinical trials- all have come to realize how important it is to:

1. Lose weight (especially some extra pounds accumulated in our abdomen)
2. Increase physical activity to at least 30- 60 minutes a day
3. Eat a healthy diet that includes more of whole grains, fiber, fruits and vegetables, lean meats, eggs, fish, beans and nuts
4. Quit smoking
5. Reduce stress levels
6. Manage dyslipidemia; maintain normal levels of cholesterol (both LDL-C and HDL-C) and triglycerides
7. Control hypertension
8. Limit alcohol consumption
9. Check for inflammation
10. Keep your hormones in balance

We keep asking for new tools for our physicians to formulate a magic pill, but let us stop and rethink how we can help our physicians formulate optimal treatment strategies for effective management of any or all risk conditions by considering the ten simple changes listed above.